PEFLOXACIN FOR FALCIPARUM-MALARIA - ONLY MODEST SUCCESS

To assess the efficacy of pefloxacin in treating Plasmodium falciparum malaria in Madagascar, an area of chloroquine resistance, we conducted a case series intervention study in a rural population. Twenty-two adults with pure P. falciparum parasitemia, and no glucose-6-phosphate dehydrogenase deficiency, pregnancy, or other illness, were given an oral dose of 400 mg of pefloxacin every 12 hours for 3 days. Pefloxacin and chloroquine susceptibilities of 10 isolates were measured by an in-vitro microtest. The overall success rate of treatment was 9 of 22 (41%; 95% CI, 20% to 61%). Sixteen patients cleared parasitemia, but late recrudescence occurred in 7. Early therapeutic failure occurred in the 6 other patients. Efficacy of pefloxacin treatment was not related to the in-vitro activity of chloroquine or pefloxacin against the corresponding strain. These data contrast with those from a preliminary report from India of successful malaria therapy with a similar regimen of norfloxacin, the main metabolite of pefloxacin in humans.